The most optimal techniques of implant attachment to the ribs

Introduction. Surgical intervention remains the most significant treatment approach for the majority of malignant tumors of the thoracic cage. In the presence of massive defects, the use of muscle and musculocutaneous flaps does not provide the necessary rigidity and structure of the thoracic wall. The optimal method in this case is personalized endoprosthesis of the thoracic wall defects developed based on anthropometric data of each individual patient.

The choice of implant fixation technique to the bone structures is an important question in orthopedic oncology because reliable fixation decreases the risk of postoperative complications and allows to achieve rigid structure of the thoracic wall. Currently, there is no consensus on the most optimal technique for implant attachment.

Aim. To determine the most reliable technique of implant fixation to the ribs in reconstruction of the rib and muscle frame of the thoracic cage after surgical intervention for tumors of the thoracic wall to decrease the risk of instability of the metal construction in the postoperative period and hospitalization time and to increase the quality of life and esthetic results of the patients.

Materials and methods. An experiment using 9 porcine ribs was performed. The accuracy of 3 different techniques of implant fixation to the ribs was determined: using screws oriented at the 90° angle, at the 45° angle relative to the bone, and using multidirectional fixation.

Results. The highest strength of the construction was observed in fixation of the implant using screws oriented at the 90° angle relative to the bone (maximal separation force – 131 kg, mean – 86 kg). Attachment to the ribs using screws oriented at the 45° angle relative to the bone and multidirectional fixation showed lower strength: maximal separation force was 34 and 39 kg, respectively, mean – 27 and 32 kg, respectively.

Conclusion. Fixation of the implant using screws oriented at the 90° angle relative to the bone is the most optimal method. This technique can be used in patients with tumor lesions in the thoracic wall who underwent extensive resection. The use of this method decreases the risk of metal construction instability in the postoperative period, decreases hospitalization time, and improves the quality of life and esthetic results in patients after surgical intervention.

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